Cholecystectomy during COVID-19: A Single-Center Experience

COVID-19 pandemic has impacted health care globally with restructuring and prioritization of health care services. We prospectively analyzed 104 patients who underwent laparoscopic cholecystectomy during the peak of COVID-19 in 2020 and compared with 217 patients from the same period in 2019. Emergency admissions constituted majority of cases with no statistical difference between both groups (p = 0.49). Most cholecystectomies were for biliary colic (41.3 vs. 35.5%) and cholecystitis (37.5 vs. 43.8%) without any statistically difference (p = 0.31 and p = 0.29, respectively). This study demonstrates that laparoscopic cholecystectomy was feasible and safe in patients with symptomatic gall bladder disease during the peak period for COVID-19.

Laparoscopic Cholecystectomy in a patient with Situs Inversus Totalis

There are diagnostic and therapeutic challenges in cases of symptomatic gall bladder disease in patients with situs inversus totalis (SIT), where there is complete reversal of visceral topography in thorax, abdomen or both. The difficulty to treat these patients with conventional laparoscopic cholecystectomy may be more pronounced for right handed surgeon and requires modifications in working ports and their positions. We present a case of laparoscopic cholecystectomy in a patient with SIT, and describe the technical details that enable the safe conclusion of the operation. Bangladesh Crit Care J March 2021; 9(1): 43-45

Conversion Rate from Laparoscopic to open Cholecystectomy in AL-kindy Teaching Hospital, Baghdad

Background: laparoscopic cholecystectomy (LC) is getting popularity for the treating of symptomatic gall bladder disease; conversion from laparoscopic to open cholecystectomy (OC) is also common. Objective : To find out the prevalence of causes, risk factors of conversion from LC to OC among patient suffering from gall bladder disease, and to explore the most common causes of conversion from laparoscopic to open cholecystectomy. Methods: This prospective study was conducted in the department of general surgery at Alkindy teaching hospital from first of January 2016 to the end of December 2017 .Nine hundred twenty patient were included. Patient age, gender, history of previous abdominal scar, common bile duct stone, ERCP, duration of symptom was included in our study. Results: Seven hundreds twenty –seven patients 74.48% were females and 191 26.52% were males. The mean age of patient presented with gall bladder disease was 40.43 years. Thirty –eight patients were converted to open cholecystectomy. The most common cause of conversation was dense adhesions 42.1% - followed by bleeding 30.1%. Other common causes of conversion were biliary anomalous anatomy 10.5%, common bile injury 5%, visceral injury and technical failure 7%. Conclusion: The main perioperative cause for OC was dense adhesion around gall bladder and the male gender, increasing age, history of common bile duct stone removed by previous ERCP, history of previous surgery, are independent risk factors of difficult laparoscopic cholecystectomy.

Multimorbidity After Surgical Menopause Treated with Individualized Classical Homeopathy: A Case Report

Classical homeopathy was shown to be beneficial in climacteric syndrome in many studies, but the clinical effect is unclear. To inspect if individualized classical homeopathy has a role in treating complaints after surgical menopause through real world case, we present a case of a 54-year-old Russian woman treated with individualized classical homeopathy for multimorbid conditions after surgical menopause examined for changes from homeopathic treatment. We assessed changes in climacteric symptoms, changes in comorbidities, and the general well-being of the patient. The woman had severe climacteric syndrome, pelvic inflammatory disease, dyslipidemia, obesity, hepatic steatosis, pancreatic lipomatosis, gall bladder disease, and mild subclinical hypothyroidism to begin with. She was treated with individualized classical homeopathy and followed up for 31 months. She was relieved of the vasomotor symptoms and psychological disturbances of climacteric syndrome, her weight reduced, the ultrasound scan showed absence of lipomatosis/gall bladder disease/hepatic steatosis. Blood tests showed reduction of thyroid stimulating hormone and a balance in the lipid status. Individualized classical homeopathy may have a role in the climacteric syndrome and comorbidities after surgical menopause. The efficacy of homeopathic therapy in climacteric problems must be scientifically investigated further.

Comparative study of standard laparoscopic cholecystectomy and single incision laparoscopic cholecystectomy: outcome and complications

Background: Laparoscopic cholecystectomy (LC) has evolved to be as gold standard treatment for gall bladder disease and is the most common laparoscopic procedure performed worldwide. In recent times, the innovative techniques of Natural orifice Transluminal Endoscopic Surgery (NOTES) and Single Incision Laparoscopic Surgery (SILS) have been applied as a step forward towards scar less surgery with added benefits of less pain and less analgesic requirement, shorter hospital stay, quick return to work.Methods: A retrospective study of 50 patients admitted with gall bladder disease through outdoor for laparoscopic cholecystectomy from November 2018 to January 2019 in Maharishi Markandeshwar Institute of Medical Sciences and Research Mullana (AMBALA) were randomized into two groups of 25 each for Single Incision Laparoscopic Cholecystectomy (SILC) and standard laparoscopic cholecystectomy (LC) comparing the operative time, outcome and complications.Results: 50 patients admitted to MMIMSR Mullana from November 2018 to January 2019 with gall bladder disease were divided into two groups of 25 each who underwent three port SILC and four port laparoscopic cholecystectomy (4PLC). The average intra-operative time in SILC (80.56 mins) was significantly more than standard laparoscopic cholecystectomy. The average length of stay in the hospital for SILC was 1.8 days (1-3 days), was significantly less than in standard four port laparoscopic cholecystectomy. Incidence of Intraoperative complications were more in SILC than standard LC.Conclusions: SILC as the newer novel technique had better outcomes in terms of cosmesis, early discharge, shorter stay at hospital.

Gall bladder agenesis: a surgeon’s dilemma

Congenital agenesis of gall bladder is a rare anomaly which poses a diagnostic dilemma to the surgical fraternity. Ultrasonography, which is the standard investigation of choice in gall bladder diseases often gives a mistaken diagnosis of cholelithiasis in the background of a shrunken gall bladder with hyperechoic shadows suggestive of gall stones. Intra-operatively this poses a surprise to the operating surgeon who fails to locate gall bladder in its normal anatomic position as well as any of the ectopic sites. The controversy in further course of management whether to abandon the procedure and follow-up with a post-operative imaging such as MRCP or to convert the laparoscopic procedure into an open surgery has been a debate for the surgeons. Most of the literature favours the first approach, thereby reducing the morbidity associated with the surgery. In this case report we present a 42-year-old male who presented with symptoms of gall bladder disease to a peripheral surgical centre and how we approached the intra-operative dilemma once gall bladder was not visualized.